SAN QUENTIN — Officials cut a ceremonial ribbon Thursday on a new, $1.6 million emergency room for San Quentin State Prison, the first step in a stem-to-stern overhaul of health care at this and all other state lockups.

It’s among the first bricks-and-mortar changes wrought by Robert Sillen, the receiver placed in charge of California’s prison health system by a federal judge in order to bring inmate care up to constitutional muster.

And by all accounts, it’s just an early, tiny step that pales in the context of what’s still needed.

The new Triage and Treatment Area (TTA) is already in use, and inmate Jay Herman, 37, looked on curiously as a crowd of reporters and prison officials filed past the hospital bed on which he reclined.

Herman, who said he’s been in and out of San Quentin for 20 years and is back now on a parole violation, said the care he receives for his diabetes and heart problems has improved a lot in the past year.

Before, he said, understaffing, poor continuity of care and substandard clinical facilities meant “you’d might as well get down on your knees and beg” for life-sustaining care. “Now it’s like a hospital. … The improvements are happening right in front of my eyes.”

Licensed vocational nurse Jake Jacobs agreed.

Since he arrived at San Quentin about 18 months ago, he said, “there’s been a lot of great changes. … We have plenty of room to do what we need to do now.”

The old TTA — serving San Quentin’s approximately 5,200 inmates — had two treatment beds in a cramped, dilapidated 400-square-foot space lacking not only medical equipment but even basic supplies such as bulk gauze and sutures.

The new TTA has four beds in a clean, freshly-painted 1,600-square-foot space with new heart monitors, crash carts and other equipment as well as secure, accessible supplies and medicine.

Warden Bob Ayers, who has worked in California corrections since 1968, said the six-month project would’ve taken at least 18 to 36 months had it gone through the state bureaucracy — assuming the state would’ve chosen to do it at all.

Instead, he said, Sillen — beholden not to the Legislature or the governor, but only to Senior U.S. District Judge Thelton Henderson — has been able to cut through the red tape and help prison officials do what they know they should’ve been doing all along.

“This has been a real plus for me,” Ayers said, adding he’s been communicating that to other wardens across the state.

That’s because the San Quentin reforms — the new TTA and other, more ambitious construction projects forthcoming, and new medical staffing and policies — will be fine-tuned and then exported to other prisons as needed.

It’ll be neither fast nor cheap. Next up at San Quentin, starting in July, will be renovation of the receiving and release building through which about 400 new inmates flow into the state prisons every week.

Sillen intends to reform the medical, dental and mental health screening every inmate receives upon entering the system. It’ll require new exam rooms, a real lab for drawing blood, a complement of newly trained assessment nurses, better sharing and storage of medical records data and more.

And environmental reviews are under way for a new $146 million, five-story, 118,000-square-foot building planned for the site of a vacant, condemned building within the prison.

Scheduled for completion in 2010 and to be bankrolled with a revenue bond sale now being considered by the Legislature, this Central Health Services Building will house 50 medical and dental beds, outpatient clinics, lab services, medical records and the prison pharmacy.

That’s just for San Quentin. Not every prison will need a new TTA or a new $146 million building, Sillen said. Needs vary by site, but every site has needs, he said

“There are no fixes in this god-awful system,” he said, adding that the San Quentin changes launched in his first year on the job are just a start. “We’re still crawling, and we’re just about ready to walk over the next couple of years. … This is the first baby step.”

Sillen is unafraid to keep drawing on the blank check the federal court has given him, despite the hand-wringing it causes in Sacramento.

“Politically, they’re not able to do these kinds of things because it’s not popular enough,” he said, adding that’s not his concern. “I only care to the extent that they have meaningful, substantive input to offer, not political rhetoric.”

(Click here if you are unable to view this photo gallery on your mobile device) The Ruth Bancroft Garden in Walnut Creek celebrates the life of its founder Ruth Bancroft who died at 109 on November 26, 2017. The Ruth Bancroft Garden is a nonprofit public dry garden that was planted by Mrs. Ruth Bancroft in 1972 and was opened to the...